I will be attending as staff:(Required)
Name(Required)
Date of Birth(Required)
Please enter a number from 0 to 120.
Address(Required)
Gender(Required)
Email(Required)
T-Shirts - $20(Required)
T-Shirts have to be pay for in advance.

Spiritual Information

Saved?(Required)
Sanctified?(Required)
Holy Ghost?(Required)
Member of The Church of God?(Required)
Do you hold any positions as a church leader?(Required)
Do you believe and practice the church teachings and advice as set forth by the General Assembly?(Required)
Are you willing to assume any responsibilities you may be placed in?(Required)
Will you abide by the rules of camp & encourage others to do the same?(Required)
Are you willing to forget about yourself & put the needs of campers first?(Required)
Can you be at camp on time & stay until released from duties?(Required)
Do you participate in your local church's activities consistently?(Required)
Will you attend camp meetings, if possible, for instruction & duties?(Required)
I am able to attend International Youth Camp (IYC) if selected to be sponsored.(Required)
IYC is August 30-Sept 2, 2024
MM slash DD slash YYYY
Have you ever been charged or convicted of a crime involving a minor or a crime that involved any sexual conduct?(Required)
The Following Must Be Answered & Signed To Be Able To Work In Camp (this is a requirement of the Insurance Company and is no reflection of The Church of God. All information received is confidential and is held at the State Office.) -The Authorization for Criminal Background Check MUST be completed if you have not previously filled one out. Contact Sis. Debbie for details.

Health Information

Name(Required)
Health Conditions(Required)
Please check all that apply.
Allergic Reactions(Required)
Please give a more detail of what you are allergic to and your allergic reactions in the box below.
If you checked any of the boxes other than NONE for the previous two questions please give details here. You may also add any additional details of concerns in this box.
All medications is to be given to the camp nurse to administer to the camper unless approved by camp administration.

Insurance Information

Name(Required)
Emergency Contact(Required)

Payment Information

Tuition Amount(Required)
FAMILY PLAN (Cost reflects ages 6 and up) (family must live in same household) Choose the plan of the number in the household that is age 6 & up. For ages of 3-5, you will add $20 to family plan to cover food cost. Ages 2 & under - no cost. The SNACK SHACK will be open to purchase snacks/drinks. This is NOT included in the tuition. Snack Shack cards can be purchased in advance or at camp. ($5 per card) *Deduct $5 from plan for each member of staff. APPLICATION DEADLINE May 1, 2023 No applications after deadline unless extenuating circumstances occur.